MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

INSPECTION REPORT

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Facility Information

Facility Name

Facility DVN

Phone

Physical Address

Owner

Mailing Address

Provider/Director

E-mail Address

Incorporated

Child Care Specialist

Age Range

Capacity

Facility Type

Limitations

Inspection Information

Date

Arrival Time

Departure Time

Notice

Inspection Type

Inspection ID

Document	Document-Date
FIRE/SAFETY INSPECTION	01/03/2022
POLICIES	04/22/2013
SAMPLE WEEKLY MENU	06/11/2012
OWNER/PROVIDER REFERENCES	06/11/2012
REGISTERING FICTITIOUS NAMES	12/31/2014
LOCAL ZONING APPROVAL	04/22/2013
LOCAL FIRE DEPARTMENT NOTIFICATION	04/22/2013
LINES OF ADMINISTRATIVE AUTHORITY	04/22/2013
JOB RESPONSIBILITIES	04/22/2013
DISCIPLINE POLICIES	04/22/2013
DIRECTOR'S QUALIFICATIONS	04/22/2013
DIAGRAM/INDOOR	04/22/2013
DIAGRAM/OUTDOOR	04/22/2013
DAILY SCHEDULE	04/22/2013
CHILD CARE PRACTICES	04/22/2013
APPLICATION	02/26/2019
STAFF SHEET	02/26/2019
EQUIPMENT LIST	04/04/2022
SANITATION INSPECTION	12/13/2021
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS	04/04/2022
ANNUAL DECLARATION	04/04/2022

Overlap Start Time	Overlap End Time	Overlap Submit Date
3:30PM	4:30PM	4/22/2013
6:30AM	7:30AM	4/22/2013

Open Violations:

NOTE

The licensee is responsible for compliance with all licensing rules, including but not limited to the rules listed on this compliance report form.

Compliance List

5 CSR 25-500.032 Organization and Administration

Compliance

5 CSR 25-500.042 Licensing Process

Compliance

5 CSR 25-500.052 Annual Requirements

Compliance

5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers

Compliance

5 CSR 25-500.087 Fire Safety

Compliance

5 CSR 25-500.090 Disaster and Emergency Preparedness

Compliance

5 CSR 25-500.092 Furniture, Equipment and Materials

Compliance

5 CSR 25-500.102 Personnel

Compliance

5 CSR 25-500.112 Staff/Child Ratios

Compliance

5 CSR 25-500.122 Medical Examination Reports

Compliance

5 CSR 25-500.132 Admission Policies and Procedures

Violation

	Provider Comments
Violation An individualized plan for specialized care for a child with special physical, developmental or behavioral needs was not on file. Licensing Rule Reference 5 CSR 25-500.132 Admission Policies and Procedures (6) states: A child who has a special physical, developmental or behavioral need shall have on file an individualized plan for specialized care from a professionally qualified source. Correction Required An individualized plan from a professional source shall be on file as required. Correction Verification Submit Documentation Compliance Date

5 CSR 25-500.142 Nighttime Care

Compliance

5 CSR 25-500.152 Hourly Care Facilities

Compliance

5 CSR 25-500.162 Overlap Care of Children

Compliance

5 CSR 25-500.172 Emergency School Closings

Compliance

5 CSR 25-500.182 Child Care Program

Compliance

5 CSR 25-500.192 Health Care

Compliance

5 CSR 25-500.202 Nutrition and Food Service

Compliance

5 CSR 25-500.212 Transportation and Field Trips

Compliance

5 CSR 25-500.222 Records and Reports

Compliance

5 CSR 25-600.020 General Requirements

Compliance

5 CSR 25-600.040 Background Screening Findings

Compliance

RSMo 210.115. Reports of abuse, neglect, and under age eighteen deaths — persons required to report — supervisors and administrators not to impede reporting — deaths required to be reported to the division or child fatality review panel, when — report made to another state, when. —

Compliance

RSMo 210.211. License required - exceptions - written notice of licensure status, when.

Compliance